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   2013| January-March  | Volume 2 | Issue 1  
    Online since March 20, 2013

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Performance evaluation of hematologic scoring system in early diagnosis of neonatal sepsis
Manisha Makkar, Chinki Gupta, Rambha Pathak, Sunal Garg, NC Mahajan
January-March 2013, 2(1):25-29
DOI:10.4103/2249-4847.109243  PMID:24027741
Objectives: The present study was undertaken to evaluate and highlight the importance of hematological scoring system (HSS) in the early detection of neonatal sepsis. Materials and Methods: The cross-sectional study enrolled 110 neonates who were clinically suspected of infection (study group) and normal neonates for comparison (controls), during the 1 st week of life. All peripheral blood smears were analyzed using HSS of Rodwell et al., by pathologists blinded to the infection status of the newborns. HSS assigns a score of 1 for each of seven findings significantly associated with sepsis: Abnormal total leukocyte count, abnormal total polymorphonuclear neutrophils (PMN) count, elevated immature PMN count, elevated immature: Total (I:T) PMN ratio, immature: Mature (I:M) PMN ratio ≥0.3, platelet count ≤150,000/mm 3 , and pronounced degenerative or toxic changes in PMNs. Score of ≤2 was interpreted as sepsis unlikely; score 3-4: Sepsis is possible and ≥5 sepsis or infection is very likely. Blood culture was taken as a standard indicator for septicemia. The perinatal history, clinical profile and laboratory data were recorded and correlated in each case. Each hematological parameter was assessed for its individual performance and also with the culture-proven sepsis. Sensitivity, specificity, positive and negative predictive values (NPVs) were calculated for each parameter and for different gestational ages. P value was also calculated for different parameters. Results: Out of the 110 infants, based on clinical findings and laboratory data were classified into three categories: Sepsis ( n=42), probable infection ( n=22) and normal ( n=46). Out of these, 42 (38.2%) newborns had positive blood culture. 63 (57%) neonates were preterm and 47 (43%) term. Male: female ratio was 0.96:1. The P value was significant for the different gestational ages (0.0002) and sex ratio (0.003). Immature polymorphonuclear neutrophils (PMN) count was the most sensitive and I:M PMN ratio, the most specific indicator of sepsis. For sepsis and probable sepsis, I:T PMN count and immature PMN count have highest sensitivity whereas I:T and I:M PMN ratio have highest specificity. HSS has much higher sensitivity and specificity in preterms than in term neonates. Positive predictive value and NPV is also higher in preterm than term for HSS. It was also seen that with increasing scores, the likelihood of sepsis also increased. Conclusion: The sensitivities of the various screening parameters were found to be satisfactory in identifying early onset neonatal sepsis. It is a simple and feasible diagnostic tool to guide towards the decision-making for a rationale treatment.
  9,830 1,843 29
An interesting observation of PDA closure with oral paracetamol in preterm neonates
Rahul Sinha, Vandana Negi, SS Dalal
January-March 2013, 2(1):30-32
DOI:10.4103/2249-4847.109245  PMID:24027742
Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus, is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with either Indomethacin or Brufen which are cyclooxygenase 1, 2 inhibitor; however these drugs are associated with side effects. We report an interesting findings of ductal closure in 10 preterm neonates (gestational age 27-33 wks) presenting with significant large PDA who had failed or had absolute contraindication with Brufen. These preterm neonates were treated with oral paracetamol in the dose of 15 mg/kg 8 hourly. The PDA closure was achieved within 48 h and there was no complication.
  6,888 972 38
Stem cell therapy for neonatal diseases associated with preterm birth
Alessandro Borghesi, Claudia Cova, Diego Gazzolo, Mauro Stronati
January-March 2013, 2(1):1-7
DOI:10.4103/2249-4847.109230  PMID:24027735
In the last decades, the prevention and treatment of neonatal respiratory distress syndrome with antenatal steroids and surfactant replacement allowed the survival of infants born at extremely low gestational ages. These extremely preterm infants are highly vulnerable to the detrimental effects of oxidative stress and infection, and are prone to develop lung and brain diseases that eventually evolve in severe sequelae: The so-called new bronchopulmonary dysplasia (BPD) and the noncystic, diffuse form of periventricular leukomalacia (PVL). Tissue simplification and developmental arrest (larger and fewer alveoli and hypomyelination in the lungs and brain, respectively) appears to be the hallmark of these emerging sequelae, while fibrosis is usually mild and contributes to a lesser extent to their pathogenesis. New data suggest that loss of stem/progenitor cell populations in the developing brain and lungs may underlie tissue simplification. These observations constitute the basis for the application of stem cell-based protocols following extremely preterm birth. Transplantation of different cell types (including, but not limited to, mesenchymal stromal cells, endothelial progenitor cells, human amnion epithelial cells) could be beneficial in preterm infants for the prevention and/or treatment of BPD, PVL and other major sequelae of prematurity. However, before this new knowledge can be translated into clinical practice, several issues still need to be addressed in preclinical in vitro and in vivo models.
  6,412 1,117 15
Congenital giant hydronephrosis: A rare cause for upper abdominal mass in the newborn
Jyotindu Debnath, Shuvendu Roy, Swapan Kumar Sahoo, Aniruddha Pandit
January-March 2013, 2(1):33-35
DOI:10.4103/2249-4847.109246  PMID:24027743
We report a rare case of antenatally detected unilateral pelvi-ureteric junction obstruction leading to congenital giant hydronephrosis presenting as upper abdominal mass at birth.
  6,102 397 2
A huge immature cervical teratoma; Antenatal diagnosis, and its management - An unusual entity
Manoj Kumar Mohanty, Pradeep Sahu, Ashwin Ashok Jaiswal, Rikki Singal, Samita Gupta, Gaurav Kohli, Amrish Kumar Garg
January-March 2013, 2(1):42-45
DOI:10.4103/2249-4847.109249  PMID:24027746
Cervical teratomas are not reported quite frequently in medical literature, especially from Indian subcontinent. Prenatal diagnosis of this condition is even rarer, making the management protocols difficult. In absence of prompt intervention in the form of airway decompression, morbidity and mortality is very high. Presented here is the case of antenatal diagnosed cervical mass, which was managed successfully in immediate post-natal period with uneventful survival and normalized tumor marker levels.
  5,144 337 5
A Saudi patient with an interstitial deletion of short arm of chromosome 3 (p13 to p21) and its association with Joubert's syndrome features
Ali Y Mersal, Mahaboob K Basha, Zaina S Brinji, Ghazal Avand
January-March 2013, 2(1):46-49
DOI:10.4103/2249-4847.109250  PMID:24027747
We report a case of 4 weeks old girl with a de novo interstitial deletion of the short arm of chromosome 3 (p13-p21) and clinical findings typical of proximal 3p deletion together with heart defects, choanal atresia, ear anomalies, central nervous system anomalies, renal anomalies and associated Joubert's syndrome (JS). Family history is unremarkable and parenteral chromosomes were normal. The clinical manifestations of the patient are compared with those of 11 patients previously described with a proximal 3p deletion. The additional JS features associated with this syndrome were described. This is the first case report in English literature describing 3p deletion associated with additional JS features.
  4,198 300 -
Correlation of pulse oximetry and Apgar scoring in the normal newborns
Sandhya Chauhan, Prashant K Singh, Pratik Gahalaut, Prem L Prasad
January-March 2013, 2(1):20-24
DOI:10.4103/2249-4847.109241  PMID:24027740
Context: Apgar score (AS) is routinely used for assessment of newborns immediately after birth. Within acceptable limits, low saturations at birth are normal in vigorous newborn babies. Various studies have questioned the reliability of AS. Aims: To detect whether AS is an accurate indicator of hypoxemia and to study the correlation of different components of AS with the arterial oxygenation saturation (SpO 2 ) levels of normal newborns in the delivery room. Settings and Design: A prospective cross-sectional observational study on normal healthy neonates delivered vaginally in a tertiary level referral medical college. Materials and Methods: SpO 2 levels were monitored continuously in the newborns with a pulse oximeter and serial recording of SpO 2 levels was done at 5 min intervals starting at 1 min of life until 30 min after birth. Simultaneously, AS was recorded in these newborns at 1 and 5 min of life. Statistical Analysis: Data was analyzed using the Mann-Whitney-U test. Results: AS at 1 and 5 min of life didn't correlate with the changes in SpO 2 of newborns. In AS; though respiratory efforts and muscle tone were significantly correlated with SpO 2 of the newborns, body color did not have significant correlation with simultaneously recorded SpO 2 . Conclusions: A revised AS in which evaluation of color is replaced by pulse oximetry monitoring would prove to be a better tool for neonatal evaluation in the immediate postnatal period.
  3,643 519 4
Probiotics for the management of infantile colic in breastfed infants
Jasim Anabrees
January-March 2013, 2(1):9-11
DOI:10.4103/2249-4847.109234  PMID:24027737
  3,383 629 1
Neck swelling in a newborn with congenital goiter
Praveen Shivayogappa Bagalkot, Bharath Adligere Parshwanath, Suhas N Joshi
January-March 2013, 2(1):36-38
DOI:10.4103/2249-4847.109247  PMID:24027744
Congenital goiter presenting in the newborn period is very rare. We present a case of primary hypothyroidism presenting as congenital goiter in the newborn period with symptoms in the immediate postnatal life. Hormone replacement therapy was started leading to normal levels of free thyroxine and triiodothyronine. In face of maternal normal thyroid levels, dysharmonogenesis was considered to be the most probable cause of hypothyroidism.
  3,629 367 3
Neonatal visits to the pediatric emergency center and its implications on postnatal discharge practices in Qatar
Samawal Lutfi, Hilal Al-Rifai, Khalid Al-Ansari
January-March 2013, 2(1):14-19
DOI:10.4103/2249-4847.109238  PMID:24027739
Background: An early discharge from postnatal policy has been practiced at Women's Hospital, Hamad Medical Corporation. Aim: This observational cohort study was conducted to evaluate the effect of early postnatal discharge practice on neonatal morbidity in the State of Qatar. Setting and Design: This is a data-based cohort study. All neonates ≤28 days visiting the Pediatric Emergency Centers (PEC) were evaluated for the need for re-hospitalization, referral for clinic appointments, or observation at the PEC setting. Materials and Methods: Differences in outcome rates were compared in neonates who visited in the first 24 hours postnatal discharge (2-3 days of life) and those who visited after the third day of life. Statistical Analysis: Crude differences in incidence rate assessed by χ2 or Fisher exact test were applicable. Results: Of 3528 PEC visits for 1915 neonates, 1.7% required admission (3.1% of neonates), 8.4% were observed, 1.1% were referred to a clinic, and the remaining were discharged home. There was no significant difference in re-hospitalization rates of neonates visiting PEC in the first 3 days and those visiting at a later age (OR 0.78, 95% CL 0.19-3.23, P=1). However, early presentations to PEC was more likely to result in periods of observation (OR 1.88, 95% CL 1.17-3.04, P=0.01), or clinic referral (OR 4.96, 95% CL 2.16-11.38, P=0.001) when compared to older neonates. Moreover, those who presented early were significantly more likely to revisit any of the PECs with in the 28 days period (OR 3.20, 95% CL 2.17-4.97, P<0.0001). Conclusion: These results clearly demonstrate the need for a structured early post-discharge follow-up service that addresses the needs of all neonates and their families. The results, however, do not provide sufficient evidence that delaying postnatal discharges for apparently healthy neonates will provide significant health benefits to these neonates and their families.
  3,403 407 1
A rare case of pyridoxine-dependent seizures in infancy
V.S.S. Yerramilli Murty, M.S.S. Kishore, Manisha R Patel
January-March 2013, 2(1):39-41
DOI:10.4103/2249-4847.109248  PMID:24027745
Pyridoxine-dependent seizures is a rare cause of recurrent seizures in neonatal period and resistant to most of the antiepileptic medications, but respond to administration of pyridoxine. We report a male infant who had neonatal seizures which were initially responsive to anticonvulsants and later became unresponsive and presented at 45 days of life with seizures. These seizures were not responding to any anticonvulsant but responded to pyridoxine. After discharge parents inadvertently stopped pyridoxine and the infant presented with seizures once again. These seizures were promptly controlled with readministration of pyridoxine confirming the diagnosis of pyridoxine-dependant seizures.
  3,375 387 -
Feeding intolerance in preterm infants fed with powdered or liquid formula: A randomized controlled, double-blind pilot study
Lena Ignacio, Khalid AlFaleh
January-March 2013, 2(1):11-13
DOI:10.4103/2249-4847.109236  PMID:24027738
  3,068 560 5
Chilaiditi syndrome: A rare manifestation in newborn
Rajdhar Dutt, Chandrakala Dutt
January-March 2013, 2(1):50-51
DOI:10.4103/2249-4847.109251  PMID:24027748
1 days newborn presents with abdominal distention, excessive cry, respiratory distress and off fed, abdominal - distended, tenders, tympanic and bowel sound high present were present. Chest X-ray - Gas between below the right colic angle between liver and right diaphragm. Treatment - Conservatives.
  3,180 333 1
Erythropoietin may improve the outcome in infants with moderate to severe hypoxic ischemic encephalopathy
Zakariya Al-Salam
January-March 2013, 2(1):8-9
DOI:10.4103/2249-4847.109232  PMID:24027736
  2,801 466 -
Mortality rate of one neonatal intensive care unit in Tehran, Iran
Zahra Jaberi, Mohammad Gholami-Fesharaki, Fatemeh Rahmati-Najarkolaei, Amin Saburi
January-March 2013, 2(1):52-52
DOI:10.4103/2249-4847.109252  PMID:24027749
  2,518 285 2